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2002, 06-19 Permit App: 02004964 MHPROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, \V1\ 99260 509-477-3675 SPECIFIC SITE INFORMATION \--- Street Address: / i 1 _I 4). d e--5,5 5S / & Assessor's Tax Parcel Number(s): 951 4' -- d 901 a2- c9 tel Legal Descripti(n: Project Description: Rear-4ev-' /C_X Ls -15%,%., SI tis) & \ I,6= TQ4(Ct t 4 Joct6Le ✓Y114.t) V Fpcfv2�'7� )/- , ni ❑ Building Permit ❑ Change in Use ❑ Grading 'Manufactured Home Permit ❑ Relocation ❑ Sign ❑ Tenant (New/Change) 0 Other ' Department. Us water Dntna/Puncvue Sewer D6mct/Punscynr'.•-'_ Road width Sctbnchs'. ^ ' Prone• Rear'.' • Left. IDghi.. School District- Fitt Distract - - /011 ,g OWNER/APPLICANT FORMATION .e stn Inrb:ate 1:910 thou/ lx oed zr&rnlin tbrr LY lTnur Phmtc ¶a,s7 -1-y53 (oLtivl 5 I,.. phcant� ) Phone Van 67 2 Srh rf4 yap -s P.'S -C.33 .6 e--- /7J NI diking Add / 1/,' 4/ iie ss/c mailing Add ret.. ///9 A) 415-5/&— 2"d hour sq ft C.”, State, Zip S'7)0Ci 4N E PO4--9ta I z cin, Soue,'/.tp .54,-.Aiv67 am_ c. c ‘.2 / •1--- 0 Contractor Thane 0 Aid -wee 0 ingmcv Phone Fd, Mailing adds c., hailing addres Op, State 'Zip Go-, State '/.gyp \\,\ Snte Cnn n.tnt hcen-t ,t canna n one PROJECT INFORMATION . Building-Informationr,b; - Budding FR ,ght to pt ah # or stone: t\latn Mur sq. 0 Unfuushcd baacment sq ft 1)1011natuns 'Total habitable space 2"d hour sq ft Finished basemcnr sq 0. ( lccupann Group Gm>trucnun type Garage sq. 0 Deck sq ft Cunt of pr. leer 11cn1 source (eductnc, gaa etc ) Iy�anufactured Home Sigh ... 4with:I // 1 ccngtli r What is the square footage of the Sign face?g 110w high is the sign? 3'car: otooa_ \Inks:I wl Ant fr.-- 7'TL-. # of signs Arca of t'ist iig signs Are there slopes greater than 30% on the property%_(30 fr nse in 100 ft) ( / %) 0 Ycs <o Arc critical or hazardous materials used or stored on sit'? 0 Yes Ai No Proposed use Value Relocation : Fire Safety. Firm Name What is the current use of this property? T^' 0 AA.-.-- Previous address \\511 the site be served by a septic system? D Yes No ...5trZ,t7E/e. Paint booth live Sprinkler Tent _ 14reworks display Fire Alarm Are there slopes greater than 30% on the property%_(30 fr nse in 100 ft) ( / %) 0 Ycs <o Arc critical or hazardous materials used or stored on sit'? 0 Yes Ai No Proposed use Value Special Inspection§ Required?' ' • , .;" : .! '" Non=Residential E iergy.Code Compliance? ' ` Firm Name What is the current use of this property? T^' 0 AA.-.-- Phone \\511 the site be served by a septic system? D Yes No ...5trZ,t7E/e. Plans Examiner Phone Inspectors Is there evidence of fill or cscavano 1 on the property% D Yes N. No Are there slopes greater than 30% on the property%_(30 fr nse in 100 ft) ( / %) 0 Ycs <o Arc critical or hazardous materials used or stored on sit'? 0 Yes Ai No Address I nspcctnr Phone D Concrete D Welding D Bolting D Reinforcement Address ADDITIONAL SITE INFORMATION A e there structures on the property% D No f yes, identify ore sitephm CA -0-34-9 a Winn t is the cut rent property sire% / (square feet or acre.) (/ o D )c \ O Is any part of the property within 250 feet of a shoreline? If yet, Identify ore tete plan D Yes No What is the current use of this property? T^' 0 AA.-.-- Is your property in a designated wildlife habitat arca% D Dont know D fess %No \\511 the site be served by a septic system? D Yes No ...5trZ,t7E/e. Is any part of the property within a 100 yr flood plain? I f yes, rdenth on site plan ' ' D Maybe D Don't know i D 1'(1' "chin Are or will there be wells located on the property+ 'lies, rrlenirfj, on the site plan O Yes At No Are there any wetlands, strcatns or ponds within 200 feet of the property? If yes. identify on site plan " ' ' D lyes �' No Is there evidence of fill or cscavano 1 on the property% D Yes N. No Are there slopes greater than 30% on the property%_(30 fr nse in 100 ft) ( / %) 0 Ycs <o Arc critical or hazardous materials used or stored on sit'? 0 Yes Ai No DEPARTMENT USE ONLY Is the property in a desigi ated Stormwater Control Area? , ,- , - ,• i i .. ,. '.D Yes ' D.No , Is"public sewer available to the site? • D Yes •' D Nip" .,. . i. .. Is the property, inside the r\Sr\?'' D: lyes - D No ,, . .. ... _.. 0 Yes+ "D' No" i Is pubhc water available to the site? D lyes' D: No -1S-the property inside the PSSA? - 0 Yes ' D No ' - ._. ' Is the property located within 1000 feet of a Natural Resource Arca? - D. Yes 0 No - ' '_ Date Rectivcd Staff Represen tact c. METHOD OF PAYMENT VISA ❑ CAsI 1 ❑ CI 1CK ❑MISEEMi El I DIICOVER FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DAl'1 EXPIRES RANKCARD NUMBER AUI'I IORILI?D SIGN.\l URN SUB -Hal -Al, TOTAL FEE MIN/AIUH PERMIT FEE /5 S35 M I'11:LE MAKIr 0 IECKS PAYABLE 10 SPOKANE COUNTY PER\III CI:N] Elt " Project Number. 02004964 Inv: I Application Date: 6/19/2002 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: DOUBLEWIDE MANUFACTURED HOME Setbacks: Front 35 Left' 16 Right' 35 Rear: 49 Site Information: Plat Key: CONY Name CONVERTED CNTY DATA Contact: COLLINS, SHERYL L Address 21725 EWELLESLEYAVE#25 C - S - Z: OTIS ORCHARDS, WA 99027 Phone (509) 928-5993 Group Nano' Project Name District E Parcel Number 45181.0901 Block: Lot: SiteAddress: 1119 N BESSIE RD SPOKANE, WA 99212 Location:: SPO Zoning' UR -3.5 Urban Residential 3.5 Water District Owner: Name: COLLINS. SHERYL L Address: 21725 E WELLESLEY AVE #25 OTIS ORCHARDS, WA 99027 Hold. ❑ Arca: 0 Sy Ft Width: 80 Depth: 150 Right Of Way (ft)' 40 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Site Plan Review Plan Review Seiicr R e l —1 f `— Permits: . . . . Contractor OWNER Item Description INSPECTION FEE COUNTYSURCIIARGE Operator DMD Released Bv' Manufactured Ihnnc First: OWNER Phone Units Unit Desc 2 SECTIONS 1 Y OR BLANK Printed By: DMD Fee Amount $100.00 $22.011 Permit Total Fees: $122.00 Print Date' 6/19/2002 Project Number 02004964 Inv. I Application Date: 6/19/2002 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: Pa)nnent Summary: Permit Tvpe Manufactured Home Fee Amount Invoice Amount Amount Paid Amount Owing $122.00 $122.00 $0.00 $122.00 $122.00 $122.00 $0.00 $122.00 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will he complied with. Subsequent issuance of a permit shall not be contrued to he a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Sign a tui e: Operator: DMD Printed By. DMD Print Date: 6/19/2002 qr, r ESS ---- ZONE- - - ROAD WID"fD NG= :FRONT + -' -- _ FiEVIEWEDs 4v�`i��%i� This site plan is being submitted for_thepurpose of cbtaimrg a !;,iilding.perrc;; and is a true and correct represen_ation of the proposal. All known property— _ - lines/dimensions, curb lines structures and easements _.- _ __have _ __have been identified: Also indicated are wetlands, bodies of wale steep slopes or other critical areas. - ' cam% '.. Signed a cr ' am '' J11 • . i F t t qr, r ESS ---- ZONE- - - ROAD WID"fD NG= :FRONT + -' -- _ FiEVIEWEDs 4v�`i��%i� This site plan is being submitted for_thepurpose of cbtaimrg a !;,iilding.perrc;; and is a true and correct represen_ation of the proposal. All known property— _ - lines/dimensions, curb lines structures and easements _.- _ __have _ __have been identified: Also indicated are wetlands, bodies of wale steep slopes or other critical areas. - ' cam% '.. Signed